My partner is about to be treated for latent secondary stage syphilis. He is 54, his HIV levels are zero/t-cells are 800-1,000. Within the last 18 months he has been experiencing more frequent moments of forgetfulness -short, middle and long term, Confusion under even low to mild stress, and cognitive problems with adding columns/reading a calendar. After a second neurological testing exam from his high scoring base line, he was one point from cognitive impairment. A follow up blood scan now is indicative of latent syphilis. Our question is how much neurological recovery is possible/likely with successful treatment of the syphilis infection

Response from Dr. Young

Hello and thanks for posting. Sorry for the late reply.

Your question poses a number of interesting aspects. First, cognitive impairment (both symptomatic and asymptomatic) is disturbingly common among people living with HIV. There are multiple causes and a lot of controversy about how to best manage screening and treatment of this condition.
myHIVclinic.org has a review of current medical thoughts about cognitive problems.

Regarding syphilis, one has to know if your partner has neurosyphilis before opining about whether treatment will help. A spinal tap (lumbar puncture) is required to look for evidence of syphilis in the spinal fluid to determine if this is a problem or not. If he does indeed have neurosyphilis, the recommended treatment is IV penicillin; and I'd expect some degree of cognitive improvement after treatment. If he doesn't have neurosyphilis, then there's no reason to think that penicillin will improve cognition.

If syphilis isn't the explanation (or perhaps even if it is), a comprehensive look for other causes of mentation would be warranted. Looking for HIV in the spinal fluid, and if detected, examination for drug resistance is reasonable. Some experts also advocate switching to HIV medications that penetrate into the spinal fluid.

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